MO611CARDIOPULMONARY RESERVE EXAMINED WITH CARDIOPULMONARY EXERCISE TESTING IN INDIVIDUALS WITH AND WITHOUT CHRONIC KIDNEY DISEASE; A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Eva Pella ◽  
Marieta Theodorakopoulou ◽  
Afroditi Boutou ◽  
Maria Eleni Alexandrou ◽  
Dimitra Bakaloudi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oxygen Uptake ◽  
Meta Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Abstract Background and Aims Patients with chronic kidney disease (CKD) often present with reduced physical activity and exercise performance due to a number of factors relevant to co-existing disturbances of the cardiac, nervous and muscular systems. Cardiopulmonary exercise testing (CPET) is widely applied in daily clinical practice used for clinical evaluation of exercise intolerance and related symptoms (i.e. dyspnea, fatigue), as well risk stratification, and other applications in several medical fields. Method This is a systematic review and meta-analysis of studies which used CPET technology in adult patients with CKD to examine cardiopulmonary reserve in individuals with versus individuals without CKD. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases; manual search of article references and of grey literature was also performed. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies. Results From an initial 4944 literature records, we identified 29 studies fulfilling the inclusion criteria; of these, 25 studies with complete data including 2213 participants were included in final meta-analysis. Peak oxygen uptake (VO2peak) was significantly lower in CKD patients compared to controls without CKD (standardized-mean-difference, SMD:-1.40, 95%CI[-1.68, -1.13]) (Figure). Oxygen consumption at anaerobic threshold (VO2AT) (SMD:-1.06, 95%CI[-1.34, -0.79]), maximum workload (weighted-mean-difference, WMD:-58.26, 95%CI[-74.14, -42.38]) and respiratory exchange ratio (RER) (WMD:-0.02, 95%CI[-0.05, 0.01]) were also impaired in CKD patients compared to non-CKD individuals. In 3 studies comparing patients with CKD versus patients with heart failure without CKD VO2peak was higher in the former (WMD:6.60, 95%CI[3.02, 10.18]). Sensitivity analyses confirmed the robustness of these findings. Conclusion VO2peak and other commonly analyzed CPET variables were lower in CKD patients compared to controls, indicating reduced functional cardiopulmonary reserve in the former. In contrast, CKD patients performed better when compared patients with heart failure.

scholarly journals A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure

2012 ◽  
Vol 18 (1) ◽  
pp. 79-94 ◽  
Author(s):  
Lawrence P. Cahalin ◽  
Paul Chase ◽  
Ross Arena ◽  
Jonathan Myers ◽  
Daniel Bensimhon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Testing ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

scholarly journals 633 Efficacy of additional medical therapies in patients with heart failure, reduced ejection fraction, and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo De Marzo ◽  
Lucia Tricarico ◽  
Giuseppe Biondi Zoccai ◽  
Michele Correale ◽  
Natale Daniele Brunetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Composite Outcome ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Abstract Aims We assessed the efficacy of add-on drugs in patients with heart failure with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD) already receiving neurohormonal inhibition (NEUi). Methods and results The literature was systematically searched for phase 3 randomized controlled trials (RCTs) involving ≥90% patients with left ventricular ejection fraction <45%, of whom <30% were acutely decompensated, and with published information about the subgroup of estimated glomerular filtration rate <60 ml/min/1.73 m2. Six RCTs were included in a study-level network meta-analysis evaluating the effect of NEUi, ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv mecarbil (OM) on a composite outcome of cardiovascular death or hospitalization for heart failure. In a fixed-effects model, SGLT2i (HR: 0.78, 95% CrI: 0.69–0.89), ARNI (HR: 0.79, 95% CrI: 0.69–0.90), and ivabradine (HR: 0.82, 95% CrI: 0.69–0.98) decreased the risk of the composite outcome vs. NEUi, whereas OM did not (HR: 0.98, 95% CrI: 0.89–1.10). A trend for improved outcome was also found for vericiguat (HR: 0.90, 95% CrI: 0.80–1.00). In indirect comparisons, both SLGT2i (HR: 0.80, 95% CrI: 0.68–0.94) and ARNI (HR: 0.80, 95% CrI: 0.68–0.95) reduced the risk vs. OM; furthermore, there was a trend for a greater benefit of SGLT2i vs. vericiguat (HR: 0.88, 95% CrI: 0.73–1.00) and ivabradine vs. OM (HR: 0.84, 95% CrI: 0.68–1.00). Results were comparable in a random-effects model and in sensitivity analyses. SUCRA scores were 81.8%, 80.8%, 68.9%, 44.2%, 16.6%, and 7.8% for SGLT2i, ARNI, ivabradine, vericiguat, OM, and NEUi, respectively. Conclusions Expanding pharmacotherapy beyond NEUi improves outcomes in HFrEF with CKD. 633 Figure

scholarly journals Cardiopulmonary exercise testing reveals subclinical abnormalities in chronic kidney disease

2018 ◽  
Vol 25 (16) ◽  
pp. 1717-1724 ◽  
Author(s):  
Danielle L Kirkman ◽  
Bryce J Muth ◽  
Joseph M Stock ◽  
Raymond R Townsend ◽  
David G Edwards
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oxygen Uptake ◽  
Exercise Testing ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
Cardiopulmonary Exercise

Background Reductions in exercise capacity associated with exercise intolerance augment cardiovascular disease risk and predict mortality in chronic kidney disease. This study utilized cardiopulmonary exercise testing to (a) investigate mechanisms of exercise intolerance; (b) unmask subclinical abnormalities that may precede cardiovascular disease in chronic kidney disease. Design The design of this study was cross-sectional. Methods Cardiopulmonary exercise testing was carried out in 31 Stage 3–4 chronic kidney disease patients (60 ± 11 years; estimated glomerular filtration rate 43 ± 13 ml/min/1.73 m2) and 21 matched healthy individuals (healthy controls; 56 ± 5 years; estimated glomerular filtration rate>90 ml/min/1.73 m2) on a cycle ergometer with workload increased by 15 W every minute until volitional fatigue. Breath-by-breath respiratory gas analysis was performed with an automated gas analyzer and averaged over 10 s intervals. Results Peak oxygen uptake was reduced in chronic kidney disease compared to healthy controls (17.43 ± 1.03 vs 28 ± 2.05 ml/kg/min; p < 0.01), as was oxygen uptake at the ventilatory threshold (9.44 ± 0.53 vs15.55 ± 1.34 ml/kg/min; p < 0.01). A steeper minute ventilation rate/carbon dioxide production slope (32 ± 0.8 vs 28 ± 1; p < 0.01) and a lower expired carbon dioxide pressure in chronic kidney disease (27 ± 0.6 vs 31 ± 0.9 vs 0.9; p < 0.01) indicated ventilation perfusion mismatching in these patients. The ventilatory cost of oxygen uptake was higher in chronic kidney disease (37 ± 0.8 vs 33 ± 1; p < 0.01). Maximum heart rate (134 ± 5 vs 159 ± 3 bpm) and one-minute heart rate recovery (15 ± 1 vs 20 ± 2 bpm) were reduced in chronic kidney disease ( p < 0.01). Conclusion This study suggests that both central and peripheral limitations likely contribute to reduced exercise capacity in non-dialysis chronic kidney disease. Additionally, cardiopulmonary exercise testing revealed subclinical cardiopulmonary abnormalities in these patients in the absence of overt cardiovascular disease. Cardiopulmonary exercise testing could potentially be a tool for unmasking cardiopulmonary abnormalities preceding cardiovascular disease in chronic kidney disease.

Effects of sacubitril/valsartan in patients with heart failure and chronic kidney disease: A meta-analysis

2020 ◽  
Vol 884 ◽  
pp. 173444
Author(s):  
Huaning Kang ◽  
Jinhua Zhang ◽  
Xiaoting Zhang ◽  
Guicheng Qin ◽  
Ke Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Patients With Heart Failure
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